OMES_Form_CP076.pdf
PDF 180 KB Posted
- Attached to
- OSDH School Nurse Pilot Project
- Solicitation number
- EV00000980
- Issued by
- Oklahoma
About this file
This is a Responding Bidder Information form (OMES Form CP076) issued by the Oklahoma Office of Management and Enterprise Services Central Purchasing division on behalf of the Oklahoma State Department of Health for the OSDH School Nurse Pilot Project (Solicitation EV#00000980). The form serves as a certification document that must be submitted along with bid responses for the contract to deliver school nurse services addressing the physical health, mental health, wellbeing, and social services needs of students and families in public school settings. The form requires bidders to provide general company information including FEIN/SSN, supplier ID, company name, contact details, address, and website information.
The form includes mandatory certifications and compliance requirements that bidders must address in their submissions. Bidders must declare whether they are engaged in boycotts of Israeli goods or services, confirm registration status with the Oklahoma Secretary of State (or provide an exemption statement), and demonstrate workers' compensation insurance coverage or claim an applicable exemption under Oklahoma law. Additionally, bidders may certify disabled veteran business enterprise status if applicable, which requires submission of federal verification of service-disabled veteran status, proof of at least 51 percent ownership by service-disabled veterans, and documentation of management control by service-disabled veterans. An authorized representative must sign and date the form with their name and title to complete the submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment_A_Agency_Purpose.pdf | ||
| Exhibit_02_Budget_Form.pdf | ||
| Bidder_Instructions.pdf | ||
| Attachment_B_General_Terms.docx | DOCX document | |
| OMES_Form_CP004.pdf | ||
| Exhibit_01_Requirements.pdf | ||
| Attachment_C_AgencyTerms_PLACEHOLDER.pdf | ||
| Exhibit_03_Third_Party_Information.pdf |
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Text version
OMES Form CP076 (11/2024) RESPONDING BIDDER INFORMATION | Page 1 of 1
Central Purchasing
RESPONDING BIDDER INFORMATION
You must submit a Certification for Competitive Bid and Contract along with the response to the solicitation.
1. SOLICITATION
Solicitation #
2. BIDDER GENERAL INFORMATION
FEIN/SSN Supplier ID
Company name
3. BIDDER CONTACT INFORMATION
Address
Contact name Title
Email Phone Website Fax
4. BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL
Yes No
5. REGISTRATION WITH THE OKLAHOMA SECRETARY OF STATE
Yes Filing number:
No Prior to the contract award, the successful bidder is required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (sos.ok.gov or 405- 521-3911).
6. WORKERS’ COMPENSATION INSURANCE COVERAGE
Bidder is required to provide a certificate of insurance showing proof of compliance with the Oklahoma Administrative Workers’ Compensation Act.
Yes Include a certificate of insurance with the bid.
No Exempt from the Administrative Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11). (Attach a written, signed and dated statement on letterhead stating the reason for the exempt status. For frequently asked questions concerning workers’ compensation insurance, visit wcc.ok.gov.)
7. DISABLED VETERAN BUSINESS ENTERPRISE ACT
Yes I am a service-disabled veteran business as defined in 74 O.S. § 85.44E.
Include the following with the bid response:
1. Certification of service-disabled veteran status as verified by the appropriate federal agency.
2. Verification of not less than 51% ownership by one or more service-disabled veterans.
3. Verification of the control of the management and daily business operations by one or more service-disabled veterans.
No I do not meet the criteria as a service-disabled veteran business.
8. SIGNATURE
Authorized signature Date
Name Title https://www.sos.ok.gov/ https://www.wcc.ok.gov/
| Central Purchasing |
| RESPONDING BIDDER INFORMATION |
| Solicitation: EV#00000980 |
| FEINSSN: |
| Supplier ID: |
| Company name: |
| Contact name: |
| Title: |
| Email: |
| Phone: |
| Website: |
| Fax: |
| 4 BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL: Off |
| Prior to the contract award the successful bidder is required to register with the Secretary of State or must attach a: Off |
| Compensation Act: Off |
| 7 DISABLED VETERAN BUSINESS ENTERPRISE ACT: Off |
| Date: |
| Name: |
| Title_2: |
| Filing number: |
| Address: |
File details come from the government source that posted it. Updated .